How long should one with acute nephritis stay in bed for rest?

Written by Li Liu Sheng
Nephrology
Updated on December 17, 2024
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After the onset of acute nephritis, patients should rest in bed for 2-3 weeks until gross hematuria disappears, blood pressure returns to normal, and edema subsides. If the patient's condition is severe, with complications such as high blood pressure, noticeable edema, and significant hematuria, then bed rest should be extended to 4-6 weeks. Bed rest can increase renal blood flow and improve kidney function, which is beneficial for enhancing treatment effectiveness. Gradually, indoor activity can be increased. If the condition does not worsen after 1-2 weeks, the patient may begin outdoor activities. Patients with mild residual proteinuria and microscopic hematuria should be followed up and closely observed without the need for indefinite bed rest. If urine changes worsen again after activity, further bed rest is necessary. For students who develop acute nephritis, it is advisable to take a break from school to ensure enough rest time for recovery.

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Written by Li Liu Sheng
Nephrology
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Acute nephritis etiology and pathogenesis

The primary cause of acute nephritis is related to antigen-antibody mediated immune damage. This means that when patients with acute nephritis are infected by streptococci, certain components within the streptococci can act as antigens and bind to corresponding antibodies produced in the body, forming immune complexes. These immune complexes circulate through the bloodstream and eventually deposit in the glomeruli. When the complement system is activated, inflammatory cells infiltrate, ultimately leading to the development of acute nephritis. Acute nephritis is a common group of primary glomerular diseases, characterized by a sudden onset, with hematuria, reduced urine output, proteinuria, edema, and hypertension as its most significant features. Once acute nephritis occurs, bed rest is usually required, along with active treatment. After treatment, most patients with acute nephritis can recover fully, with few recurrences.

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Written by Hu Lin
Nephrology
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What causes acute nephritis?

The full name of acute nephritis is post-infectious glomerulonephritis, so as the name suggests, acute nephritis is related to infections. The most common cause is acute streptococcal infection. There are also infections caused by Staphylococcus aureus, Staphylococcus epidermidis, and Gram-negative bacteria. The main pathogenic mechanism is due to a series of immune responses caused by streptococcal infections, leading to an immune complex-mediated glomerulonephritis. The most common sites of infection are the respiratory tract and skin, with a latent period of one to three weeks.

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Written by Zhou Qi
Nephrology
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Sequelae of acute nephritis

Most cases of acute nephritis do not cause complications; generally speaking, acute nephritis is a self-healing disease that can recover on its own. Approximately three to four weeks later, the condition can gradually alleviate, with the patient’s urine protein and occult blood decreasing until they disappear and kidney function returns to normal, and the edema can also subside, so generally there won’t be any complications. However, there are a minority of patients whose conditions are prolonged and do not heal, and if the patient's condition persists for three months or even half a year without recovery, it might evolve into chronic nephritis. Also, some patients may experience severe kidney failure, heart failure, and pulmonary infections during acute nephritis, leading to severe consequences. The likelihood of these situations occurring is relatively low.

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Written by Zhou Qi
Nephrology
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Symptoms of Acute Nephritis

Acute nephritis may present with some clinical symptoms. The main characteristics are that patients may have hematuria and proteinuria. When there is a significant amount of blood in the urine, it can be detected by the naked eye, known as gross hematuria. For instance, the color of the patient's urine could be dark like strong tea or bright red. Patients might also experience increased urine foam due to the presence of proteins in the urine, especially in cases where there is a significant presence of urinary proteins. A minority of patients may experience acute renal failure, often characterized by reduced urine output, or even anuria. Due to the reduced urine output, the water intake of patients cannot be fully excreted, leading to edema. Patients may experience swelling of the facial and bilateral lower limbs or even the whole body.

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Written by Zhou Qi
Nephrology
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Is acute nephritis prone to "excessive internal heat"?

Acute nephritis indeed tends to cause "fire-up," which refers to the viral infection in patients. Typically, the appearance of herpes on the upper lip is colloquially known as "fire-up," but in reality, this is an active manifestation of the herpes virus when the body's immune capacity is low. The human body often carries this virus, and symptoms appear when immunity is low. In the state of acute nephritis, it is easy to result in reduced immunity in patients, thus activating the dormant virus in the body, causing herpes in corresponding areas including the upper lip and corners of the mouth.